Will a Chatbot Be Just What the Doctor Ordered for Reimbursement Appeals?

Bianca Ho, co-founder of Clare.AI, says security and compliance are also important components to providing chatbots to financial institutions.Clare.AI doesn’t keep or use data with personal information. Other variations the company has offered include reimbursing customers more and more money as a flight delay drags on. For instance, a 45-minute delay could mean a $45 reimbursement, while a 10-hour delay would qualify the consumer for a $600 payout.

Good Doctor is huge in mainland China, where it provides teleconsulting, appointment bookings, and medicine home deliveries. The business model is similar to Ping An Good Doctor, while Cigna aims at the health-insurance market for local, Cantonese-speaking residents. Lebrón also reports incidents including travel rings operating in the US and Europe, who were inventing bogus claims.

It helps insurers mitigate risks, minimize financial losses, and maintain the integrity of their operations. By mimicking human perception, reasoning, learning, and problem-solving capabilities, AI has the potential to transform insurance from a reactive “detect and repair” approach to a proactive “predict and prevent” strategy. This shift will impact every aspect of the industry, from brokers and consumers to financial intermediaries, insurers, and suppliers.

Before the user is given access to a chatbot, the user must log in first with a username and password. Once the user is authorised, the user accesses the chatbot based on the user’s role. So far in the literature, none of the previous studies on the security of chatbots have considered using STRIDE for threat elicitation or focussed on the insurance industry. Thus, more understanding of insurance chatbots’ security threats and vulnerabilities is needed.

In-depth analysis

Tekin says there’s a risk that teenagers, for example, might attempt AI-driven therapy, find it lacking, then refuse the real thing with a human being. “My worry is they will turn away from other mental health interventions saying, ‘Oh well, I already tried this and it didn’t work,’ ” she says. Cigna is the first insurance company to work with the service and commercialize it. Lost luggage is the bane of many travellers, and not a good start or end to a holiday or business trip. Smart Luggage has harnessed one of the latest uses of parametric technology to offer real-time technology for airline passengers who cannot locate their checked luggage upon arrival or departure. It’s the brainchild of Just Travel Cover, which partnered with CPP Group UK to create the product.

Progressive insurers are embracing the transformative power of AI to improve their operations, attract customers and enter new markets. Let’s examine this paradigm shift and explain how insurers who are on the fence about AI can get started with it. Noncommercial use of original content on is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated.

The algorithm used health costs to determine health needs, but that reasoning was flawed. “Less money is spent on Black patients who have the same level of need, and the algorithm thus falsely concludes that Black patients are healthier than equally sick White patients,” according to the study. If AI can do more of the administrative work, doctors can get back to being doctors.

The Argument for AI in Health Care

The bot is through chat, but also through text message, and we can talk about that, because I actually think that’s pretty cool. There are various drawbacks to generative AI, including the possibility of biased or erroneous outputs as a result of the data used for training. It also has difficulty recognizing context beyond its training data, making it less successful ChatGPT App for complicated, multidimensional tasks that need human judgment and ethical considerations. Omni focuses on streamlining onboarding and offboarding processes using generative AI to automate and customize communications, track important documents, and remove manual data entry. This allows a seamless integration for new hires and a smooth transition for exiting staff.

Insurers such as Geico, Allstate, and Lincoln Financial were among the pioneers of chatbots in insurance. Of the four companies examined in this report, only Progress Software did not have any case studies available showing success with their software. That being said, the other companies only had one case study for their NLP solution for insurance.

Travel insurance providers rely on huge amounts of unstructured data – often in the form of pictures and scanned documents – to determine the veracity of a claim. Insurers are seeking opportunities to reduce the amount of information required from a customer in order to make a decision on a claim. “We are aided in our search by the technology in online portals, which allows us to test variations on the requirements and the information that we need to speed up the process,” Page says. You should see the chatbot’s responses in the terminal, guiding any off-topic conversations back to insurance-related topics.

That’s a modest start, but the technology could potentially become more important once it starts to be used by the end customers. PortfoPlus could help agents set up a website or app in which customers can ask ChatGPT about their own insurance needs. Since then the team has rolled out other tools designed to help agents and it has about 4,000 users who pay for its software-as-a-service, says Colin Wong, CEO and co-founder (pictured, center). PortfoPlus is a startup that launched in 2018 initially with a policy wallet that agents could use to aggregate a customer’s insurance products. That would give agents a holistic view of a customer’s insurance and wealth profile, which would give the agent an edge in providing advice and pitching products. Woebot tracks a user’s mood, finding patterns that might be more difficult for the average user to analyze.

We will continue to monitor how the insurance industry evolves as we anticipate the field will continue to be impacted by AI overtime. The company’s strategic move aligns with research on insurance trends published by The Boston Consulting Group and Morgan Stanley. The report projects an increasing decline in personal lines and a “65 percent reduction of the personal auto insurance market by 2030.” A contributing factor to this trend is the anticipated debut of autonomous vehicles. Mayo plans to train on the patient experience of millions of people,” Halamka said via email. “Since all physicians may not be familiar with the latest guidance and have their own biases, these models have the potential to steer physicians toward biased decision-making,” the Stanford study noted.

• Project Management Institute (PMI) designed this course specifically for project managers to provide practical understanding on how generative AI may improve project management tasks.
• After filling out this information, Nayya’s platform then matches each individual or group with a benefits plan that best aligns with their circumstances.
• AI-powered chatbots can cross-sell and upsell products based on the customer’s profile and history.

The chatbot makes use of natural language processing to comprehend the intent of consumers accurately to provide highly relevant responses. Allstate supports small business owners with ABIE (“Abbie”), an AI-powered tool that helps customers get answers to questions and locate critical documents via an onscreen avatar that can have naturalistic conversations with insurance agents. Through the use of contextual knowledge and intelligent content, ABIE is able to address what coverages work best for certain businesses, what incidents each coverage covers and more. Afiniti improves the quality of customer conversations by matching callers with customer service reps based on best fit, rather than call order.

Before joining Zywave, he honed his skills for a decade at

Accenture, where he led technology initiatives for Global 1000 companies. He also served in executive roles at venture capital-

and private equity-backed SaaS companies, such as SAVO, OpinionLab, Local Offer Network, and RiverGlass. The Colorado AI Act, which goes into effect on Feb. 1, 2026, insists developers and deployers of AI high-risk systems must use care to protect consumers from any known or reasonably foreseeable risks of algorithmic discrimination or bias.

The growth of generative AI consulting in insurance is unstoppable in this age of innovation. Insurance companies that embrace and take advantage of its potential will prosper in a market that is becoming increasingly competitive, where flexibility and adaptability are essential for success. Not only that, but these technologies also allow for predicting potential losses and providing valuable recommendations. AI enables insurers to enter new markets, price more competitively, reduce loss ratios, settle claims more efficiently and transfer knowledge.

Generally speaking — be mindful of the choice of tools you provide an agent, as these are the only tools that the agent will use to answer each of the intermediate steps. If it doesn’t, it will usually iterate a few times (i.e. trying one of the other available tools or its own logical reasoning) and finally return a sub-optimal ChatGPT answer. “Mental-health related problems are heavily individualized problems,” Bera says, yet the available data on chatbot therapy is heavily weighted toward white males. That bias, he says, makes the technology more likely to misunderstand cultural cues from people like him, who grew up in India, for example.

Author & Researcher services

The app will be available with over 2600 other integrations in the ecosystem, providing granular control to users for safe management of third-party access. Brown worries that without regulations in place, emotionally vulnerable users will be left to determine whether a chatbot is reliable, accurate and helpful. She is also concerned that for-profit chatbots will be primarily developed for the “worried well”—people who can afford therapy and app subscriptions—rather than isolated individuals who might be most at risk but don’t know how to seek help. In an experiment that Koko co-founder Rob Morris described on Twitter, the company’s leaders found that users could often tell if responses came from a bot, and they disliked those responses once they knew the messages were AI-generated.

IBM is creating generative AI-based solutions for various use cases, including virtual agents, conversational search, compliance and regulatory processes, claims investigation and application modernization. Below, we provide summaries of some of our current generative AI implementation initiatives. Hyper-personalization leverages a wide range of data sources, including customer demographics, behaviour patterns, and preferences, to create highly tailored insurance products. For example, AXA uses AI algorithms to analyse customer data and provide personalised policy recommendations based on individual risk profiles and coverage requirements. Hyper-personalisation involves using data analytics and AI to tailor insurance products and services to individual customer needs and preferences.

PortfoPlus brings ChatGPT to insurance agents

ML models assess the severity of damage; predict repair costs from historical data, sensors, and images; and settle basic claims. Lemonade boasts that its chatbots, Jim and Maya, can secure a policy for consumers in as little as 90 seconds as well as settle a claim within three minutes. In this article, we discuss how and where banks are using natural language processing (NLP), one such AI approach—the technical description of the machine learning model behind an AI product. Health Fidelity offers software called HF Reveal NLP, which they claim is a natural language processing engine that enables many functions in the risk management software they offer to insurers. They also claim the software can handle unstructured data such as written notes in clinical documents, which has helped past clients use data they could not before. Natural language-processing capabilities and an understanding of customer data mean AI could become an excellent solution to provide a more personalized, efficient and convenient user experience in banking and financial services.

In turn, AI users must adopt a risk management policy and program overseeing the use of high-risk AI systems, as well as complete an impact assessment of AI systems and any modifications they make to these systems. You can foun additiona information about ai customer service and artificial intelligence and NLP. But it’s the constraints of Quiq’s bot that make it well-suited for a service bot use case, particularly in a regulated industry. Even with those constraints, it’s far more engaging to interact with LOOP’s bot than the frustrating service bots that are still the norm on most home pages. However,  I was able to occasionally get LOOP’s bot to offer a boilerplate/static answer, when I felt the bot could have positioned LOOP’s differentiated insurance services better. But then again, we don’t always get completely accurate information from human agents either – we’ve all been in that type of call center purgatory at one time or another. For this particular scenario, I see this as an issue of regulatory compliance on the one hand, and accuracy on the other.

• 3 min read – With gen AI, finance leaders can automate repetitive tasks, improve decision-making and drive efficiencies that were previously unimaginable.
• Answering minor health queries like that also frees up healthcare professionals to spend more time on their core activities.
• However, that can be easily implemented in LangChain and will likely be covered in some future article.
• Learn the latest news and best practices about data science, big data analytics, artificial intelligence, data security, and more.

It talks to users about their  mental health and wellness through brief daily conversations, taking into account what’s going on in the user’s life and how they are feeling that day. Woebot also sends useful videos and other tools depending on the user’s mood and specific needs. The cost-saving potential of artificial intelligence only adds to its appeal to banks and other financial companies. If you’re looking for an investment opportunity, consider some of the stocks above, as well as other AI stocks or AI ETFs if you’re looking for a broad-based approach to the sector. In July 2024, Robinhood acquired Pluto Capital, which is a free trading platform that’s supported by LLM and other AI-powered tools to help users create and automate trading strategies, for an undisclosed sum.

The insurance industry is a competitive sector representing an estimated $507 billion or 2.7 percent of the US Gross Domestic Product. As customers become increasingly selective about tailoring their insurance purchases to their unique needs, leading insurers are exploring how machine learning (ML) can improve business operations and customer satisfaction. Experts worry these systems could cause real-world harms and amplify forms of medical racism that have persisted for generations as more physicians use chatbots for help with daily tasks such as emailing patients or appealing to health chatbot insurance examples insurers. As ever, while customers appreciate the speed of response from a robot, it can’t replace the need for real-life interaction with a human who can empathise with a customer’s situation and offer support when they need it most. Lost luggage and flight delays can be simple to deal with, but when it comes to a sick child in a remote country with limited or basic medical care, then speaking to an experienced assistance coordinator is invaluable. Whilst the risk of fraud can increase with less human interaction, automation can be used to help combat this and mitigate such risk.

This information usually comes from the customer making the claim, but further claims help the software to recognize more terms and phrases. This software can be applied to applications designed to help customer service agents, who may need to search for the correct information through an intranet or similar employee resource. Progressive Insurance is reportedly leveraging machine learning algorithms for predictive analytics based on data collected from client drivers. Progressive claims that its telematics (integration of telecommunications and IT to operate remote devices over a network) mobile app, Snapshot, has collected 14 billion miles of driving data. Progressive incentivizes Snapshot for “most drivers” by offering an auto insurance discount averaging $130 after six months of use. Advances in artificial intelligence — such as Chat GPT — are increasingly being looked to as a way to help screen for, or support, people who dealing with isolation, or mild depression or anxiety.

French-based travel insurance company Koala, a digital-first insurance company that creates white-label and embedded insurance solutions, has developed a delayed flight product. In the event of a delay, the customer is proactively contacted and automatically compensated with a predefined lump sum. Whether you’re building a chatbot for customer support in an insurance company or any other specialized application, understanding how to effectively implement guardrails is crucial. On Reddit forums, many users discussing mental health have enthused about their interactions with ChatGPT—OpenAI’s artificial intelligence chatbot, which conducts humanlike conversations by predicting the likely next word in a sentence. “ChatGPT is better than my therapist,” one user wrote, adding that the program listened and responded as the person talked about their struggles with managing their thoughts.

Customers opt-in for this program to earn a substantial premium discount, while insurers can estimate risk better. Insurtech startups and scale-ups such as Clover Health, Fabric, GetSafe, Trov, Lemonade, BIMA, Slice, neos, ZhongAn use AI to successfully challenge traditional companies. Many tech disruptors focus on delivering their services to the insurance industry. The development of open-source frameworks drives the rise of AI in the entire insurance industry. Companies have also learned how to collect and process big data sets, which are shared among organizations – also across the sectors. It will not be necessary for the object to be insured to be physically present at the spot.

But when AI came into play, it let even non-musicians compose music with the help of generative AI tools. These tools can create background music, compose music, and even generate voices, and can be used in different ways, such as video soundtracks, voiceovers, or educational videos. Within 16 hours, the chatbot posted more than 95,000 tweets, and those tweets rapidly turned overtly racist, misogynist, and anti-Semitic. Microsoft quickly suspended the service for adjustments and ultimately pulled the plug. In November 2021, online real estate marketplace Zillow told shareholders it would wind down its Zillow Offers operations and cut 25% of the company’s workforce — about 2,000 employees — over the next several quarters.

By extracting and analyzing data from invoices, Yooz generates entries and categorizations, streamlining the approval process and enhancing financial operations’ efficiency. The application seamlessly integrates with existing financial systems, which provides a smooth transition to automated processes without disrupting workflow. Sell The Trend’s platform helps e-Commerce businesses uncover trending or popular products. It employs AI algorithms to analyze market data and predict which products are likely to gain popularity.